Ears: Otitis media, Otits externa, TM perforation, mastoiditis

Question 1

Define otitis media?

Answer 1

Inflammation of the middle ear caused by infection.

Frequently occurring after a viral URTI.

Question 2

Cause of otitis media?

Answer 2

Bacterial infection after a viral URTI.

Question 3

Presentation of acute otitis media?

Answer 3

ear pain
fever
conductive hearing loss
otorrhoea (TM perforated)
aural fullness
erythema of TM

irritability
vomiting
systemic illness

Question 4

Presentation of chronic otitis media?

Answer 4

Benign:
- dry TM perforation without chronic infection

Chronic secretory otitis media (GLUE EAR)
- persistent pain lasting wks
- TM initially looked abnormal and reduced membrane

Chronic suppurative otitis media:
- persistent purulent drainage (perforated TM)

Question 4

Diagnosis/IVx of otitis media?

Answer 4

Clinical

Question 5

Management of otitis media and otitis media with effusion?

Answer 5

Otitis media:
- most cases can resolve within 3 days up to a week without abx.

• analgesia (for pain and fever)
• abx (can be given immediately, delayed prescription, or NO abx -depends on pt presentation, significant co-morbidities/systematically unwell or immunocompromised)

1ST LINE: amoxicillin (if allergic, offer clarithromycin; offer erythromycin in pregnant women allergic to penicillin)

Otitis media with effusion:
- refer for audiometry to establish diagnosis and extent of hearing loss.

• resolves without tx within 3 months.
• if problem lasts >3months, then perform GROMMETS (tiny tube inserted into TM to allow fluid to be drained from the middle ear into the ear canal).

Question 6

Complications otitis media?

Answer 6

Extra-cranial:
- Facial nerve palsy
- Mastoiditis
- Petrositis
- Labrynthtitis

Intra-cranial:
- Meningitis
- Sigmoid sinus thrombosis
- Brain abscess

Question 7

Define otitis externa?

Answer 7

Inflammation of the external ear canal.

Question 8

Causes of otitis externa?

Answer 8

Pseudomonas species
Staphylococcus aureus

Question 9

Presentation of otitis externa?

Answer 9

Ear pain (otalgia)
Pruritus
Hearing loss (if meatus becomes blocked by swelling or discharge)
Minimal discharge
Erythema
Swollen canal

Question 10

Diagnosis/IVx of otitis externa?

Answer 10

Clinical

May have cultures to determine organism and abx tx.

Question 11

Management of otitis externa?

Answer 11

Mild/Moderate OE:
- analgesia
- topical drops e.g. combined abx/steroid drops like GENTAMIX, ACETIC ACID
- keep ear dry for 7-10 days

Severe OE (TM not visible):
- ENT referral with oral abx

Question 12

Complications of otitis externa?

Answer 12

malignant otitis externa
infection can spread to skull base, which can lead to severe pain, nerve palsies.

Question 13

Define tympanic membrane perforation?

Answer 13

Hole in the TM.

Question 14

Diagnosis/IVx of tympanic membrane perforation?

Answer 14

Clinical
Otoscope

Question 15

Presentation of tympanic membrane perforation?

Answer 15

Otalgia
Otorrhea
Sudden hearing loss
tinnitus
vertigo
Signs of URTI -fever, cough, sore throat, generally unwell

Could occur due to abuse -safeguarding.

Question 16

Management of tympanic membrane perforation?

Answer 16

Heals itself within 2 months

Avoid putting anything in the affected ear.

Avoid water in the ear, esp while showering.

Analgesia (acetaminophen, ibuprofen)

Abx

Refer if not healing

Question 17

Define mastoiditis?

Answer 17

Occurs when suppurative infection (causes yellow discharge) extends from affected middle ear to mastoid air cells.

Stems from otitis media.

Causes inflammation of the mastoid and surrounding tissues, and may lead to bony destruction.

Question 18

Presentation of mastoiditis?

Answer 18

Protruding ear
Post-auricular/mastoid swelling, erythema, tenderness.
Systemically unwell

Question 19

Diagnosis/IVx of mastoiditis?

Answer 19

Clinical
Consider CT to confirm diagnosis

Question 20

Tx of mastoiditis?

Answer 20

Admit to hospital for IV abx